Author + information
- Kunal Verma1,
- Caitlin Cheshire2,
- Nitesh Nerlekar3,
- Liam McCormick4,
- James Cameron, Professor5,
- Martin Bennett6,
- Ian Meredith7 and
- Adam Brown8
- 1MonashHeart, Monash Health, Melbourne, Australia
- 2Monash Heart, Melbourne, Victoria, Australia
- 4MonashHeart, Monash Health, Melbourne, Victoria, Australia
- 5Monash Cardiovascular Research Centre, Clayton, Victoria, Australia
- 6Cambridge University Hospitals, UK, Cambridge, United Kingdom
- 7MonashHeart, Monash Health, Melbourne, Victoria, Australia
- 8Papworth Hospital, Cambridge, United Kingdom
Intravascular ultrasound (IVUS)-guidance use decreases major adverse cardiovascular events (MACE), including restenosis, during implantation of bare-metal stents. However, there is debate whether IVUS improves outcomes and lowers restenosis rates when utilized during PCI with first or second-generation drug-eluting stent (DES) platforms.
MEDLINE, Embase and PubMed were searched for studies comparing outcomes between IVUS and angiography guided PCI. Among 909 potentially relevant studies, 15 trials (6 randomized controlled trials) comprising 8,265 patients met inclusion criteria by specifying DES type. The primary endpoint was MACE, defined as death, myocardial infarction, target vessel revascularization (TVR) or stent thrombosis.
Overall, 3,974 patients underwent IVUS-guided and 4,291 angiography-guided PCI. There was no statistical heterogeneity (I2=0%, p=0.66). Overall, IVUS-guidance was associated with significant reduction in MACE (Figure). In total, 5,108 and 3,157 patients received first- and second-generation DES, respectively. IVUS-guidance was associated with significant reduction in MACE in both first- (OR 0.79, 95%CI 0.67-0.92, p=0.03) and second-generation DES (OR 0.56, 95%CI 0.41-0.77, p<0.001). Importantly, IVUS-guidance significantly reduced TVR rates in second- (OR 0.47, 95%CI 0.28-0.79, p=0.008), but not first-generation DES (OR 0.88, 95%CI 0.70-1.11, p=0.73).
IVUS-guidance is associated with improved clinical outcomes in PCI with DES, although reduced restenosis rates were only observed in second-generation DES platforms.